Aggressives Verhalten psychisch Kranker im stationären Bereich: Häufigkeit, Risikofaktoren, Prävention

Abstract

In contrast to Angloamerican and Scandinavian countries inpatient violence was not regarded as a problem in German-speaking countries for a long time. Only recently it has become a topic of increasing interest for clinical practice and research, whereby the present data exhibit significant parallels to the international development. After the discussion of methodological problems (e. g. varying definitions, sources of information, ways of registration) the paper presents the current state of knowledge about inpatient violence:Underestimation in general, mainly with respect to female patients; only a few patients are responsible for the majority of assaults; victims are rather staff members than fellow patients; discrepancy between the mostly minor physical, though major emotional consequences for victims; considerably negative effects on patient-staff interactions and ward climate. Aside from patient-related actuarial and dynamic risk factors (social origin, previous history of aggressive behaviour, dissocial personality traits and - partly - diagnoses, acute intoxication, substance abuse, lack of insight and compliance, psychotic symptoms) external/contextual factors as patient-staff ratio, ward size, structure and climate, staff-attitudes, recognition of early warning signs and handling of risk situations are of major importance for the frequency and severity of incidents. Intervention and prevention strategies are focussing - aside from medication - on the aforementioned staff-related factors and patient-staff interactions. They are the principal basis for sufficient inpatient treatment beyond the problem of violence.

Inpatient risk management with mentally ill offenders: results of a survey on clinical decision‐making about easing restrictions

“…For them, dynamic factors are thought to play the predominant role during treatment. This agrees with previous findings and considerations (Steadman and Morrissey, 1981;Schanda and Taylor, 2001;Steinert, 2002). (2) Under clinical conditions, protective factors seem to be considered as almost as important as risk factors.…”

“…Moreover, shortterm predictions of incidents and violent behaviour of inpatients might be more related to dynamic than to static factors (Schanda and Taylor, 2001;Steinert, 2002).…”

A risk profile of the aggressive psychiatric inpatient: can it be identified?

“…An amerikanischen Klinken ist Gewalttätigkeit von Patienten ein ziemlich häufiges Phänomen, es wird von einer Prävalenz zwischen 4-23% [5,12,14,18] aller Aufnahmen berichtet. Deutschsprachige Studien nennen eher niedrigere Zahlen mit Prävalenzraten von 2-3% aggressiver Patienten [23,20,17].…”

Psychiatric nurses' attitudes towards inpatient aggression: preliminary report of the development of attitude towards aggression scale (ATAS)

“…psychopathology [Yesavage, 1983;Swanson et al, 1990;Beck et al, 1991;Oster et al, 2001;Tardiff, 1984], environmental or setting variables, e.g. ward characteristics [Depp, 1976;Bouras et al, 1982;Nijman and Rector, 1999;Bradley et al, 2001;Kumar and Bradley, 2001;Schanda and Taylor, 2001], interactional variables, e.g. adverse stimulation [Sheridan et al, 1990], and staff variables, e.g.…”

“…adverse stimulation [Sheridan et al, 1990], and staff variables, e.g. education and attitudes [Schanda and Taylor, 2001]. The current study focuses on one of these staff variables: the attitude of nurses towards aggression.…”